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In the USA, indigenous groups are the second largest owners of forest land Throughout Latin America traditional peoples occupy some of the most thverse regions in the world but until recently, indigenous people have been excluded from the conservation equation. In 1994, The Nature Conservancy (TNC) convened a workshop in Panama to investigate the role of traditional people in conservation Tradmonal Peoples and Btodtverszty Conservation m Large Troptcal Landscapes presents eight case studies from Latin America and the Caribbean, which were discussed at the workshop The volume concludes with several chapters that synthesize the discussion. The studies include discussions of the Kuna in Panama, Maroons m Jamaica, and Huaronl of Ecuador The case studies fall into two categories Some authors seem to mystify indigenous knowledge. J. Bedasse and N. Stewart write, "To survive in this inhospitable terrain meant that the Maroons had to become one with nature, respecting the environment and using it to their advantage." N Wray and J. Alvarado, state, "As long as nature is not altered or destroyed around them, they [indigenous people] do not need to learn from the conservatlonlsts." Other authors take a more rational approach, J Clay notes that conservation is not a top priority for indigenous peoples Rather, their main concern is land and resource rights K Hdl contrasts the indigenous and conservationist's posmon accurately when he writes, "The dilemma is, that conservationists wish to protect natural resources and native peoples wish to exploit them " Both Hill and I. Giannml make it clear that indigenous knowledge about biodlverslty is not exhaustive Rather, it is biased toward the resources and processes that are important for survival. A Stocks lists common misconceptions that conservation and indigenous organizations have about one another. The four concluding chapters analyze and synthesize what has been said in the case studies. R. Smith examines the meaning sustamablhty, a term frequently used by conservationists but rarely defined. Non-timber products are often promoted as alternatives to destructive forest harvesting Smith cites an indigenous crafts project that marketed hammocks and "shlgras" (woven bags) made from fibers of the "chamblra" palm Astrocaryum spp Lack of management led to overharvestlng of the palm The Importance of this text becomes all the more evident when Allyn Stearman notes that TNC has essentially no expenence in working with traditional peoples. TNC's mission, stated several times in the text, is "to preserve the flora, fauna, and natural commumties that represent the diversity of life on Earth by protecting the land and water that they reqmre for survival " Notably absent is any mention of the indigenous people who occupy much of the lands of interest to conservationists This volume moves to rectify that omission K. Redford observes that traditional peoples see little difference between using nature and conserving it Like many conservation models, TNC has practiced "get the people o u t " Stearman contrasts this approach with the Huaronl concept of biodiverslty, which includes humans Tradlttonal Peoples and Blodlversity Conservation shows that despite differmg agendas indigenous people and conservationists do share many goals. Part of the problem is adequate commumcatlon. Hill's list of potentaal conflicts between conservataon agendas should be reqmred reading for anyone working with conservation issues and traditional people The text provides little botamcal information, but it gives good background on history and ethnlcxty and pohtics affecting indigenous people. It is well suited for biology, geography or anthropology courses deahng with tropical conservation

Mr. Rhind on Worms. l 143 In this country the subject of intestinal worms has been much neglected. Dr. Hooper published, in the year 1799,* an interesting paper on the five species of worms which are found within the intestinal canal of the human body. He confines himself, however, entirely to a description of the external appearance and anatomical structure of these, without giving any information regarding their his-tory> symptoms, and method of cure, or at all mentioning tbe different species of worms which inhabit the other cavities and textures of the body. Dr. T. Bradly has added "ut little to the subject. JDr. Chamberlain wrote expressly for the purpose of recommending a particular medicine for the cure of tasnia, &?c. in the Stizolobium, or cowhage, and does not enter upon a general description of worms.
Possessing, then, hitherto, such meagre and unsatisfactory information upon the subject, it appeared to the author of this Essay that a work on the nature and treatment of intestinal worms was yet a desideratum in this country, and to supply this want the present Treatise has been attempted.
Mr. Rhijsd has adhered to the classification and specific ^ascriptions of Rudolphi, and from the work of Dr.
?"REmser he has culled much useful and appropriate information. He is also occasionally indebted to Dr. Hooper f?r his anatomical descriptions. The most approved practice of this country is given, together with a view of the j^ode of cure adopted by Bremser. The drawings have ^een executed by Captain T. Brown, f.r.s.e., whose knowledge of natural history is said to enable him to delicate the different objects with more fidelity than could be expected from a mere copyist. Of the formation of worms in the intestines.?Such is the "^position in nature for the support of animal existence, u.nder every variety of circumstance, and in every possible s\tuation, that all animals, even down to very minute spejles, have other animals, still smaller, which inhabit their lQdies, and derive their nourishment, and live, and propagate their species, in their various textures. " Of these parasitical animals which are found among the vari-?VS classes of the animal kingdom, Rudolphi enumerates 1100 afferent species. Some of these worms are common to several passes of animals, but others again are peculiar to and only found ln one particular species. " The Ascaris lumbricoides, or large round worm of the human * Memoirs of the London Medical Society, vol. v.
T4f CRITICAL ANALYSES. species, is to be met with also among pigs, horses, and cows; whereas the two species of tapeworm found in the human body are distinct from those of all other animals.* " Every different structure and cavity of animal bodies will be found liable to be tenanted by these animals; and, for the most part, to be exclusively inhabited by a particular species. There have been worms found in the brain, in the lungs, in the liver, the biliary ducts, and even in the heart itself; and Hopkinson and Morgan discovered a species of worm (the Filariapapillosa) in the anterior chamber of a horse's eye. We find, also, in the tenth volume of the Transactions of the Royal Society, another worm, which is described by Captain Brown as a new species, the Ascaris pellucidus, which also inhabits the eyes of horses in India, and may be seen swimming about in the aqueous humor with great activity.
" Tt sometimes happens that the eggs and larvee of various insects get introduced into the body, and are there developed ; but these are not to be confounded with the animals which are peculiar to, and exist and propagate their species in, the cavities of the human body. It is of these latter that a particular description is proposed to be given in the following pages.
" That the intestinal worms of the human body are of a peculiar kind, and different from any which are found to exist in the earth or water, is sufficiently evident from their distinct and peculiar formation, from their living and propagating their species in the body, and from their incapability of sustaining life for any length of time if removed out of it. These worms, when exposed to cold air or water, very quickly die ; whereas, had they previously existed in the earth or water, the change could not have so completely affected them. " If they were not distinct worms, but come from without, why not also inhabit the same parts of the body promiscuously?
Whereas it will be found that some of the species live in the small intestines, and others, again, always in the large." (P. 13.) Supposing it to be true that the intestinal worms of the human body are different in appearance from any which are found to exist in the earth or water, it does not follow they are " of a peculiar kind." For it is well known that considerable alteration of structure will result from change of food and habitation, in worms or the larvae of insects introduced into the human intestines from without. A difference of food, for instance, alone produces a growth and development of sexual organs in the honey bee, and ^ay be also true that worms which have been long resident the intestines, " when exposed to cold air or water, very quickly die," and still they may have previously existed in the earth or water. Such a change may have occurred in .he constitution of these animals, from the circumstances Just referred to, that they are no longer capable of bearing jhe effects of those external agents, amidst which they were by nature destined to live. But, in fact, Linnzeus himself Pointed out that the Taenia solium exists, though much jailer, in muddy springs. Menander also, cited by Rosen, unzer, and Tissot, declares that he has found in water the ?ame species of worms that inhabit the human body!* Dr.
remser is of opinion that the origin of worms in every ody is at flrst by a primitive or spontaneous formation; the l^dungstrieb of many German physiologists. This hypo-"esis is opposed by Mr. Rhind, and we think upon very olid grounds. Such a doctrine is unsupported by a single ^ct. It is contrary to all analogy drawn from the animal kingdom: for in no other class ot animals is there an instance of spontaneous formation.t We believe it is generally admitted that " a certain state of the system and ?Wels is necessary to favor the production of intestinal Jforms, and that a healthy state of the bowels is sufficient to resist them, even should they be introduced either alive 0r in the state of eggs." Pallas has demonstrated by experiment that worms may be propagated by the injection of keir^eggs into the body.
?i ?5y a small incision, he introduced into the abdominal cavity 0 a dog the eggs of a taenia from another dog; and, after the expiration of a month, he found young teenise in the cavity. In this Case> not being within the intestine, they were not liable to be e*pelled by the healthy action of the bowels; and the natural ^artnth and moisture of the abdomen favored their production. (p. 22.) .In many cases it may doubtless be very difficult to deter-^?ne in what manner worms are produced in the intestines p other parts of the animal body. Upon this subject Mr. tk offers several suggestions, which are very similar to . e opinions given by Good in his Study of Medicine^ (v?l* P? 306.) Without having recourse to the doctrine of eluivocal generation, it must be presumed that the origin of Diet, des Sciences Med. tome 57, p-213. . fa .. was originally supposed by Aristotle that, during the P?cei?s of putrek l0n 'n animal fluids, worms were spontaneously formed. This opinion has . n maintained by some modern authors, amongst others Needham, who was denied by Voltaire for having asserted that eels were created in mutton vy!?REv. worms is ab externo. As a proof of the extrinsic origin of the Ascarides vermiculares, we may mention the following fact recorded by Dr. T. M. Barry:* " In the year 1797, a family residing near the town of Macromp, in Ireland, suffered severely from this species of worm; and. upon examination, it was found that a spring, from which they constantly drank, was infested with worms which corresponded in appearance with the ascarides." The opinions of the author as to the causes of the formation of worms are in unison with those commonly maintained. A general laxity and debility of the whole system* but more especially a feebleness of the intestines, is the disposition of body which is most prone to worm affections. " A want of due harmony, too, between the several parts of the alimentary system, an imperfect digestion of the food, and a deficiency of the various juices necessary for converting this food into nourishment, or an overactive digestion, producing more alimentary matter than the absorbent vessels can take up, are both equally favorable to the production of worms.
It is well known that certain kinds of diet have an effect in predisposing the body to worm diseases; such as crude raw vegetables, unripe fruits, various sweetmeats, &c. Salt, from its stimulating qualities, is known to be a preventive of worms.
.Lord Somerville, in his address to the Board of Agriculture, relates the following circumstance; * Transactions of the Royal Irish College, vol. iw " The ancient laws of Holland ordained men to be kept on bread ^lone, unmixed with salt, as the severest punishment that could be inflicted upon them in their moist climate. The effect was horrible. these wretched criminals are said to have been devoured by worms engendered in their own stomachs.
Salt, too, when given to graminivorous animals, besides its other beneficial effects as a stimulant, is of advantage in causing the destiuction of the various intestinal worms to which this class of animals are table.
For this purpose it has also been used as a remedy for saeep with diseased livers; which disease is frequently caused by tie o g-?ttent of a peculiar worm in that viscus. (P. 33.) Spirit drinkers have been found less liable to woims.
They have been expelled from the intestines by using alcoholic liquors as a remedy.
^r. Rhind gives a very accurate anatomical description the various species of worms that infest the human body. *?r this part of the subject we must refer our readers to the ^ork itself. An abstract from it would be but of little service without the plates, which illustrate the peculiar formation of each kind of worm.
Symptoms attending the presence of worms: " The appearance of the countenance is changed, it is generally Very pale or of a leaden colour, with a red circumscribed spot in ??ne or both cheeks. The eyes lose their brilliancy, the pupil is ^nlarged, and a blue rim is perceivable round the under eyelid.
The nose is swelled, and very generally the upper lip is somewhat tumified, and there is a continual itching and irritation in both fhese. Sometimes, too, there is a bleeding from the nose. There also headach, throbbing in the ears, a foul tongue, more saliva y*an natural in the mouth, and the breath is very fetid, especially 111 the morning. The appetite is variable: sometimes it is quite ??ne, and at other times it is voracious, with a continual gnawing Sensation at the stomach. There is also nausea, and a desire to ^?mit: when this takes place, the fluid ejected is limpid like water, fhere are often violent gripings, and these are principally felt at)0ut the umbilical region. The alvine excretions are glairy, ancl ??metimes tinged with blood. The urine is turbid, and, after it has deposited a sediment, it has the appearance ol milk-and-water.
belly, too, is hard, and has a feel like a drum. There is a ??pneral emaciation of the body; the sleep is troubled, accompanied by grinding of the teeth. The patient is generally lazy and '^doleru; sometimes in good and sometimes in irritable temper, ?^lindness, deafness, delirium, even apoplectic and epileptic fits, ave been known to have their origin from worms. Ihe last and t^ost decisive symptom observed is, that in the matter vomited, ut more generally in the alvine excretions, entire worms or por-tlQns of them are perceived.
?^0. 360,?No. 3'2, New Scries. ^ " It must be remarked, that all the above symptoms are not always found in the same individual; nor do any of them, except the last, exclusively indicate the presence of worms. One or more of these symptoms may be indications of the existence of several other diseases, as water of the head and some others; but when these symptoms occur, and cannot be attributed to any other cause, the strong-presumption is that this cause is worms.
At the same time it may be mentioned, that worms sometimes exist, and that in considerable quantities, without causing any in* convenience or any bad symptoms whatever." (P. 105.) It must not be too hastily concluded, because worms, or portions of worms, are voided during-the existence of disease, that the malady has been caused by their presence-They nmy have previously existed in the intestines, and, from the altered state of the body, or the effect of medicines, may have been expelled.
" It is in this way that the notion of worm epidemics and fevers must have originated. Fever, when it seizes a patient, generally proves the death of the worms contained in the body: and this circumstance occurring in those in whom worms had previously existed, had very naturally given rise to the erroneous conclusion that these worms were the cause, and not the effect, of the fever. (P. 108.) Much difference of opinion has existed as to the fact whether worms perforate the coats of the stomach and intestines.
Rudolphi and Bremser are of opinion that they tl? not.
There are many cases on record, however, which prove the contrary.# We now come to the most interesting-, but unfortunately* in the,present state of our knowledge, not the most satisfactory, part of the subject, the method of cure.
Our object is twofold: first, to destroy and expel the worms; second, to correct that particular state of the o-eneral system, and especially the intestinal canal, which lias been the cause of their formation. The author is of opinion that those medicines which are given with a view of destroying* intestinal worms by their mechanical action, are of very doubtful operation, and in all probability owe the whole of their good effects to the powerful purgatives with which they are either conjoined or immediately followed. " Even the cowhage (Stizolobium), a remedy so much recommended by Chamberlaine, and which for a considerable time was in much vogue for the cure of taenia, though calculated to act as * Cases in which Lumbrici were evacuated by Ulceration through the Parietes of the Abdomen, By W. Young, m.?. (Glasgow Med. Journal? Nov. 1828.)?Rev. the most powerful mechanical agent, from the peculiarly sharp, penetrating, and minute spiculi of which the down of the pods is composed; has never been found effectual, unless purgatives are Used at the same time." (P. 113.) Of the cure of the maw, or threadworm, (Oxyuris verroicularis,) and Ions: threadworm, (Trichocephalus dispar.) ?These two species are found in the large intestines, or lowest part of the intestinal canal. Sometimes they cause little or no inconvenience. More frequently t ey pro uce great irritation, heat and pain about the anus, especially after exercise. They are most common in children, and sometimes cause convulsions. . , . , " Those medicines given by the mouth, with a view to their destruction, generally, in the course of the long passage through the mtestines, lose their peculiar virtues, and become ot little use .
injections, therefore, are most to be depended on. Aloes, however, are known to have the property of acting particularly on the Return and ccecum, and of passing through the other small intes-?-lnes little changed : from two, three, to six grains of aloes, given 1Q a pill or powder every morning, often destroys these worms in c?nsiderable numbers."* (P. 115.) Dr. Bremser's mode of cure consists in the exhibition of Purgatives and bitters. The formulae of his prescriptions Ul'e given. Dr. B. has found the irritation relieved, and the worms destroyed, by an injection of any of the common ?ils. In obstinate cases he advises the fumes of tobacco, or atl enema of the infusion of the male fern. " As these worms most commonly affect young children, it is of Sreat consequence to have the medicines exhibited in as small bulk possible. The following can be given disguised in a little jelly, R. Pulv. Aloes, gr. xvi.; Pulv. Scammonise gr. viij. ; Sacch. 3i. Misce. To be divided into four or eight powders, accordino to the age of the child; one powder every morning. .

"
The following injection is then to be given : R. 01. Terebinth. SIM 01. Olivar. Jij. Misce, pro enema. Or, R. Pulv. Aloes 3SS. 0 be dissolved in a little milk or gruel for an injection. " The quantities in both the above to be doubled, if necessary, acc?rding to age, &c.
, " The infusion of tobacco, also, in the proportion of 31. of the eaves to lib. boiling water, letting it stand ten minutes, is also a Powerful enema." (P. 117.) * It is well known that worms are very partial to milk. And for the pur-Pose of effecting the expulsion of those species which inhabit the rectum, it as been proposed to place the patient in a hipbath, of milk, by which they be allured from their abode. This plan has sometimes succeeded even 111 cases of taenia. (Diet, des Sc. Med. tome 57, p. 199.)?He v.
Sometimes these worms escape from the arm and creep into the vagina, causinggreat irritation. Injections ot equal parts of cold water and vinegar, repeated frequently* will be found to destroy them. Of the cure of the long round worm (Ascaris lumbncoides).'?These worms are found in the small intestines, and feed on the pure chyle. They sometimes exist m adults.
" These worms are generally easily expelled ; but, to ensure this completely, as also the destruction of their eggs, it is proper to persevere with the vermifuge medicines for some considerable time, and to keep up a continued action in the intestinal canal-A combination of medicines, too, which act on every part of the alimentary canal in succession, will be found the most complete and efficacious." (P. 120.) Purgatives, succeeded by tonics, are required. To prevent future attacks, the diet and state of the digestive system must be strictly attended to.
Of the cure of the Bothriocephalus and Taenia, or tapeworm.?To dislodge these worms is a task of great difficulty.
They frequently cause considerable mischief. Dr. Bremser tells us that he has treated more than 5G0 persons of different ages, affected with tapeworm, with uniform success.
None of his patients, after going through the proper course of medicines, having had occasion to apply to him again-He commences by giving the same electuary he recommends for the other species, for several mornings in succession. We subjoin the formula: J? ensure the complete eradication, not only of the worms, but of their eggs. If there is a disposition to form glairy Matter in the intestines, a tonic medicine is given, consisting of compound tincture of aloes, tincture of muriate of iron, ?nd elixir of vitriol. Dr. B. is aware that this prescription ls unchemical: experience, however, has proved its efficacy. ]-je restricts the patients to no particular regimen, except forbidding them the use of dry leguminous substances, too much farinaceous diet, and all substances of au oily and fatty nature. He considers the empyreumatic oil of Chabert a"n effectual cure for worms, especially tajnia, much so as to supersede the use ot all other remedies.
Rudolphi alsb bears testimony to its success As it is apt |? produce nausea, griping, and strangury, the dose should be^niall at first, and gradually increased.
ivir. Rhind thinks, and we believe correctly, that the oil turpentine is the active ingredient in this medicine. ^ ^ ^ he oil of turpentine, when taken alone, is very apt to pass off )T the urinary vessels, and to affect the neck of the bladder, ereby causing1 great irritation, and often strangury. By being k?nJ?ined with the castor oil, it more readily passes off by the ?\velsj and, exhibited in this manner, is a sure and efficacious ^edy against the most obstinate cases of taenia, and may also be |Iyen for the expulsion of the round worm and small thread worm: 0r the latter, either bv the inouth or, what is far better, in the IOri? of an enema.
During the exhibition of the medicine, the Patient should drink copiously of bland broths, such as beef-tea, c-j and, if there is any irritation in the bladder, the free use of infusion of linseed will be found to allay the uneasiness and Some patients cannot bear more than from twenty to thirty ?ps of the oil of turpentine, while others can take one to two re^? w'th impunity: the dose, therefore, should be cautiously ^Sulated at first, so as not to frighten or disgust the patient.'* 129.) ^Vhen all traces of the worms have disappeared, we must ?nceavour to prevent their future formation, by attending species are voided alive, to whose existence respiration in some form is absolutely necessary.
In the fourth volume of the Transactions of the King and Queen's College in Ireland, a singular case is recorded by Dr. Pickells, of a young woman who discharged, at different times, an immense quantity of insects from her stomach, chiefly of the beetle tribe. The author has repeatedly seen the larvae of the various species of moths, of the common flesh-fly, &c. voided from the bowels.
The following case was communicated to Mr. Rhind by Mr. A. Anderson, surgeon, Haddington. " Robert Dixon, farm servant, Markle, Haddingtonshire, was, in the summer of 1826, engaged in driving lime to the fields, and was in the habit of frequently drinking from the ditches on the roadside. In the end of the same year his disorder commenced with an increased desire for food, a vomiting up of fetid slimy matter from his stomach, which made him cough, and with which he was attacked two or three times a day: nearly half a pint would come up at a time, accompanied with sour belchings and eructations, and a most obstinate state of bowels, five or six days sometimes intervening without a stool. He felt a swelling and fulness of the right superior portion of the stomach, which was very painful when pressed. Slept very well, except on his right side; for, when he attempted to lie on it, an almost continued working up of the slimy matter took place, which made him sit upr and brought on cough. " He continued in this state till June 1828, using a variety of medicines, and undergoing a variety of medical treatment, without any relief. " On the 17th June, Mr. Anderson was consulted, and ordered him a strong solution of carbonate of soda, and pills of calomel? hyoscyamus, and extract of gentian. On the second day after the exhibition of these medicines, in one of his severe fits of vomiting? he ejected from the stomach an animal of about four inches >n length, which proved to be the common species of gray snail, (the Ximax major.) It was quite lively and vigorous when voided, and lived in Mr. Anderson's possession for five days afterwards. After this the patient's distressing symptoms of vomiting, &c. disappeared, and he is now (10th October) about to resume his usual occupation." (P. 140.) It would be but an equivocal compliment to say that Mr-Rhind's treatise contains more information than any previous work upon intestinal worms, after having stated that hitherto this subject has been much neglected in this country. The practical inquirer will find in this essay a satisfactory account of all that is known upon the subject.
Notwithstanding the confidence with which Dr. Bremser lnapamphletof forty-nine duodecimo pages, Mr. Fraseb has given usopinions in a great variety of important subjects, but in a manner which renders it impossible to follow him, without writing at much greater length than he has thought proper to do ; his notions are given not only without order, but in such total defiance of order, that it would be an easier matter to render an intelligible account of Good's Study of Medicine than of this tiny production. We shall, therefore, for our own satisfaction, and the reader's ease, glance at the principal points named, not fully stated, much less argued, in the following order : first, the origin of the disease ; second, its nature; third, its treatment.
With regard to the first point, it is difficult to ascertain things be, if the fever is endowed with contagious properties ? Surely such plain, prominent, incontrovertible facts ought to open the eyes of every man who is not determined to keep them shut; and, to remove every reasonable apprehension regarding the importation of this disease, we are persuaded that the medical superintendent of quarantine, and similar functionaries at Gibraltar, will do wisely to look closely at home for the cause of their epidemic fevers, instead of turning their eyes and inquiries to Siam, Bulam, or Havanna; that they should throw on their fears of foreign invasion, and try to defend themselves against a climatic enemy; and that, if they seek carefully and skilfully, they will find within their own walls, and in their own houses, abundant cause for all their suffering from epidemic fever.
Secondly. Of the nature of this fever we shall only say a very few words, as we hold opinions on the subject, in some measure peculiar, and as this is not the place, j* there were opportunity, to set them forth; but we think it right to state why we cannot agree with Mr. Fraser in one or two particulars.
Respecting the often agitated question of second attack, Mr. Fraser agrees with Mr. Pym, who gave himself much trouble to secure to himself the honour of discovering what does not exist. That those who have once had the fever in question, the Bulam of Pym, the epidemic fever of Mr. Fraser, (a good latetudinarian name, by the by,) are not very susceptible of the disease, for a considerable time at least, we believe, and indeed have the means of knowing? but that one attack constitutes any thing like perfect immunity from another, it is now too late to maintain. For proofs on this point, it is enough to refer to Dr. Burnett's work on Mediterranean Fever, as far as Gibraltar is concerned; and, if the epidemic fevers there be of the same nature as the concentrated fever of the West Indies, a cloud of witnesses have testified, and many more are ready to testify, that no such absolute immunity is known to them. As this is simply a question of fact, it must be decided, as in other cases of evidence, by the number and credibility of the witnesses ; and, as the case has already been heard and decided, the number, on the one side, being large, clear, and consistent, and, on the other, few, confused, and equivocating, we may dismiss it at once, and for ever.
Mr. Fraser says, in pointing out the difference between what he calls the endemic and epidemic fevers of Gibraltar, the bilious remittent and Bulam of Mr. Pym, that, in the former, there is little delirium. We are not prepared to question the accuracy of this assertion, as applied to Gibraltar ; but, if it is meant of remittent fever generally, there can be no difficulty in pronouncing-it incorrect.
Among other records, let Mr. Fraser read Yr-Johnson's Work on Tropical Diseases, and he will find that fierce delirium is a common symptom of what is usually called bilious remittent fever. If this be the case in remittent fever elsewhere, and every body acquainted with the disease knows that it is the case, it may be so on some occa-S1?ns at Gibraltar, and what then becomes of the diagnostic ?
Further, in attempting to mark the tvvo forms of fever, Ir. Fraser assures us that the endemic is "never infectious nor contagious," and that the " epidemic is obviously infectious.'' This reminds us of a notable specimen of induction in the " Elements of Medical Logic," Counting to this : The difference between the contagious f*nd noncontagious fevers of the West Indies is to be kn?wn, among other things, by the fact one is contagious the other not contagious. When men propose to teach us, we reasonably look for something by which we be made wiser, and we are simple enough to think that we acquire little knowledge by being told that a th?ng is so because it is so, whether the information be ^?nimunicated by the senior physician to the king, or by ? medical superintendent of quarantine at Gibraltar, thirdly. On the subject of treatment, Mr. Fraser is ocularly meagre, vague, and unsatisfactory. The object UlS informntinn ne fur nc if rvnpc nnnoaro tQ Jjg chiefly 32, we are ^ information, as far as it goes, appears to be chiefly s>Uard against bloodletting. Thus, at page 32, we are " Free and continued purgatives, chiefly calomel, colocynth, an{l gamboge, a strict antiphlogistic regimen, (generally speaking,) great care being taken not to overcharge the stomach ; at the same time, abundance of broths, or diluents, were at command, together with warm baths, general and topical. Wine, sodavvater, and porter, were freely used in convalescence. In fine, g?od nursing, the constant and apt exhibition of all those comforts so generally attainable in British practice, were found essential to the cure ; the most expensive wines were occasionally issued, and the caprices of the sick indulged ; pure and cool air was indispensable ; warm lavations and baths were acceptable, but cold effusion was dangerous, if not mortal, and it was uniformly dreaded by the patients." (P. 31.) .The only remark we shall offer on this paragraph, containing the marrow of Mr. Fraser's therapeutical dictions, is to suggest to the author, that it might not be amis* to take another look at Robert Jackson's book on febrile disease.
We can affor(l to give only one more specimen of Dr. Christie does not profess to give a complete history of cholera, but, " by associating the observations of others with his own, he proposes to investigate its pathology, and endeavour to explain its symptoms, and the mode of action of the various remedies which have been employed for its cure." It appears that the first cases of cholera which the author was enabled to investigate convinced him that the received opinions relating to its pathology were all more or less incorrect, and that the principal seat of the disease was in the whole mucous system ; and, with the laudable desire of being better prepared to distinguish the precise effects of cholera on the mucous membranes, he instituted experiments on some of the lower animals; a few of which experiments are prefixed to this work, together with short remarks on the general pathology of mucous membranes. The latter commences thus: " Inflammation, while it is the most frequent, appears also to be the most simple, morbid condition to which the various textures of the body are liable; and, in almost every texture, disease, however much it may vary in its progress and termination, is, with few exceptions, ushered in by inflammation. " I will endeavour to show that the mucous system affords a remarkable exception to this general rule; for, in addition to in* flammation, it is liable to another simple morbid ^affection, viz. catarrh, which often occurs alone, without being accompanied or having been preceded by inflammation. I conceive, then, that mucous membranes are liable to two distinct kinds of diseased action, viz. inflammation, evinced by one or more of the following signs, viz. increased heat, pain, redness, and swelling; and catarrh, characterised by the secretion of the membranes being depraved and increased in quantity." (P. 7.) And, " It has been stated as a general law, by several eminent authors, that inflammation of muccus membranes is accompanied by increased mucous secretion; and pathologists almost invariably attribute catarrh to an inflammation of the mucous membrane in which it occurs. This, I apprehend, is far from being correct; for are there not numerous examples of inflammation of a mucous membrane without increased secretion, and of catarrh without inflammation?
We have examples of the former in ophthalmia, inflammatory sore throat, some cases of gastritis, and perhaps also of enteritis ; of the latter, in a few cases of common catarrh, in diarrhoea, and also (as I shall have occasion to show in a future part of this essay) in Indian cholera." (P. 9.) If we correctly apprehend the author, it appears to us that he here affirms much more than he can prove, or Dr. Christie on Cholera. 161 otherwise he ushers in with great importance as new, what has never been doubted: for surely there is no novelty in the opinion that inflammation is not always attended with increased mucous or other secretion, or that increased mucous secretion is not necessarily the effect of inflammation.
On the other hand, it is evidently opposed both to reason a?d to experience to deny that inflammation is compatible with increased secretion ; since if, as is generally believed, jhe matter secreted is in all instances derived from the olood, and if it is also true that inflamed organs contain, ceteris paribus, the greatest quantity of blood, then it^ is rational to conclude that one of the effects of moderate inflammation in mucous membranes would be an augmentation of their secretions ; and daily practice tends to confirm "s m this belief, since we are constantly meeting with pajlents who, with all the acknowledged signs of inflammation, tlfVe-a^so *ncreased secretion. But it may be asked whe-? it is logical to allow that to be sometimes an effect of ""animation which is not always so, especially when we a*/1* same effect may arise from a different cause? i e reply, that this is not more extraordinary than the acn?wledged tendency of excessive inflammation of muscular Parts to prevent the union of wounds, although that union ls effected by what is called adhesive inflammation. That 0lJe degree of inflammation should diminish secretion, ^nile another increases it, is, in fact, not more wonderful lan that sleep should be promoted by one degree of fa-'8^e, but prevented by another. ^n this part of his work the author certainly does not eiript us to dwell, and we shall quote only one more pasge from his " general remarks on the pathology of mucous lnembranes:" . " It is an important law of the animal economy, that there is ? ways a determination of blood towards a part whose action is '^creased. In catarrh, the action of the excretory vessels of a j^Ucous membrane is increased; a determination of blood, there-0r^> takes place towards them; and there is a consequent diminution of blood towards the surface. The size of the pulse, and eat of the skin, are thereby necessarily diminished. These are ,requently referred to debility ; but such an explanation is plainly |nadniissible ; for, in these cases, it is not the action of the vessels, . ut only the quantity of the blood circulating through them, which diminished, whereby their caliber becomes contracted. For the ^?nfirmation of this view of the subject, we have only to appeal to acts. Great venous congestion is always found in the viscera of . e thorax and abdomen of those who have died of catarrhal affections. Were the smallness of the pulse, in these diseases, owing to debility, we might expect that this smallness should occur, and that the natural fulness should return gradually ; but we invariably find that the size of the pulse is very rapidly diminished when the secretion of the gastro-enteric mucous membrane is increased, and as rapidly restored to its natural condition upon the secretion being checked. Hence it is clear that the smallness of the pulse is owing to the blood having been withdrawn from the surface. (P. 16.) / struggle of the constitution, which, in the attempt to relieve itself from the oppressive influence of some deleterious cause, transgresses the laws of order and sympathy, and becomes the sport of diseased and irregular action : and, consequently, these morbid tendencies must not be cited as subversive of a theory supported by numerous observations and sound reasoning. We know that objections have been started against the theory of the " cutaneo-hepatic sympathy,but we are persuaded that it cannot easily be proved to be erroneous and unfounded.
The author attributes cholera not to inflammation, but to diseased action of the mucous membranes ; and his main reason for doing so is founded upon a belief that the disease always leaves traces of its operation in some part of that system, while other organs and systems are only occasionally affected. " In all the dissections I have made, the following appearances have been present: A whitish, opake, viscid substance was found adhering to the surface of some portions of the mucous membranes; and in many cases it was so abundant in the intestines as completely to fill parts of them of a greater or smaller extent. The stomach, and portions of the intestines, were filled with a transparent or turbid serous fluid; and frequently the viscid matter mentioned above was found intimately mixed with the serous fluid, or floating in it in the form of flakes. The mucous membranes (except when inflamed) had an unnatural whiteness, were fre* quently soft and pulpy, and in general (eapecially in the stomach and small intestines) could be easily detached by scraping, in the form of a thick pulp, from the subjacent coat. These appearances were sometimes more or less partial; but some of them were generally found throughout the whole extent of the alimentary canal. They extended, in some cases, to the mucous membrane of the bladder and ureters; and were found, in two or three instances, in the pulmonary mucous membrane." (P. 46.) " The morbid appearances that have been found next in frequency to those already mentioned, are venous congestion in the viscera, particularly in those of the abdomen; dark-coloured blood in the veins, and sometimes in the left side of the heart; and inflammation in some part of the mucous membranes. I have generally found inflammation (when present at all) confined to the pyloric extremity of the stomach and small intestines. I have also met with many cases in which no inflammation could be detected. (P. 48.) Many respectable names may, however, be citedj who have not constantly found organic disease of the primse viae in those who die of cholera, and who believe that, when / such alteration of structure has occurred, it ought to be considered an effect and not the cause of the disease: they ave also considered the cerebral affections the primary and ?ost fatal. " In many cases the purging and vomiting have npt been very violent, and people have suddenly become giddy, fallen down, and, after one or two slight efforts to voiuit, have expired within a few minutes; and almost all Who have been attacked have had some giddiness and pain ?f the head, a tendency to stupor, and have often become a jittle deaf. In two cases which I have seen, the jaw became ^cked for a time, but soon relaxed." (Dr. Alexander ^ordon, Bombay Report.) The same gentleman mentions a!s? a well-marked case of cholera, in which the abdominal scera evinced no trace of disease, though the brain presented many morbid appearances. Indeed, it would be ?fficult, on Dr. Christie's theory, to account for the unu-?Ually rapid fatality of this disease which is observed in some ^stances. W hoever is not totally unacquainted with the history of Solera, and the many speculations to which it has given riSe> will perceive that Dr. C. pretends to no originality Inspecting it, besides that of referring the disease to a mor-?d condition, not merely of the mucous membrane of the . omach and intestines, but also of the whole mucous sysem: and on this point, he himself informs us, that he " has it in his power only two or three times" to verify his ?P^nion as far as it is peculiarly his own. , *he author's remedies for cholera are rather numerous, ut do not differ from those usually employed for its cure, ^2. bloodletting, blisters, and sinapisms, hot sand, fumigations, frictions, calomel, opium, alcohol, ether, Sic.; on e Merits of each of which he separately discourses; but n the treatment of the disease we shall be content with Muotincr one Gf jjjg general remarks: . " In the catarrhal cholera there will always be two principal lD(iications of cure, viz. to remove the diseased action of the muc?us membranes, and to restore the circulation of the blood towards the surface. The first will always be present; the second 0nly after the disease has made some progress, and in all severe Cases. But, in order to effect these indications, we shall require to ernploy different means under different circumstances, and to vary ?Ur remedies according as certain symptoms predominate or are Ranting. We cannot expect, therefore, to discover any remedy specific that will be applicable in all cases; and it is clear that . ^re is just as much necessity for a practitioner to exercise his Judgment in treating this as in treating any other disease in the ^hole range of the nosology." (P. 100.) Dr. Christie certainly manifests considerable industry and much professional information} yet we fear he has brought his theory respecting cholera prematurely before the public? since it is not sufficiently supported by unequivocal facts.
Though his remarks are sometimes judicious and interesting, yet, as we have already endeavoured to show, his conclusions do not always appear logical; and he occasionally takes great pains to establish points, concerning which, we believe, scarcely a doubt is entertained.